BRIDGE BACK TO LIFE CENTER, INC. (NPI# 1336566694) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336566694 |
| Entity Type | Organization |
| Organization Name | BRIDGE BACK TO LIFE CENTER, INC. |
| Practice Address |
175 Remsen St Suite 1010 Brooklyn NY 11201-4333 |
| Mailing Address |
4271 Hempstead Tpke Bethpage NY 11714-5708 |
| Practice Telephone | 7188525552 |
| Practice Fax Number | 7188525666 |
| Mailing Telephone | 5165206600 |
| Mailing Fax Number | 5165206750 |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2018-11-07 |
| Authorized Official Name | MR. GARY BUTCHEN (PRESIDENT) |
| Authorized Official Telephone | 5165206600 |
| Authorized Official Credential | LCSW-R, SAP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
141211343 | NY | Nursing Service Providers |
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
141211343 | NY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01439087 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790102051 | Bridge Back To Life Center, Inc. | Social Worker | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2014-03-25 |
| 1265859078 | Bridge Back To Life Center, Inc. | Registered Nurse | 4271 Hempstead Tpke, Bethpage, NY 11714-5708 | 2014-03-19 |
| 1184041998 | Bridge Back To Life Center, Inc. | Registered Nurse | 3044 Coney Island Ave, 3rd Floor, Brooklyn, NY 11235-5660 | 2014-03-19 |
| 1518918101 | Bridge Back To Life Center, Inc. | Counselor | 500 8th Ave, Suite 906, New York, NY 10018-6504 | 2006-05-16 |
| Street Address |
175 REMSEN ST SUITE 1010 |
| City | BROOKLYN |
| State | NY |
| Zip Code | 11201-4333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306807144 | Anne J Crenesse | Family Medicine | 175 Remsen St, Suite 1101, Brooklyn, NY 11201-4333 | 2006-03-31 |
| 1427659879 | Thomas Franklin Sulzman | Counselor | 175 Remsen St, Brooklyn, NY 11201-4333 | 2020-11-03 |
| 1568079713 | Rebecca Ann Kazis Walker | Social Worker | 175 Remsen St, Brooklyn, NY 11201-4333 | 2020-09-30 |
| 1871105049 | Edith Hoffmann | Peer Specialist | 175 Remsen St, Brooklyn, NY 11201-4333 | 2020-08-19 |
| 1265067136 | Kristi Makris | Counselor | 175 Remsen St, Brooklyn, NY 11201-4333 | 2020-03-11 |
| 1689208290 | Margaret Rogers | Social Worker | 175 Remsen St, Brooklyn, NY 11201-4333 | 2020-02-24 |
| 1275178782 | Medjhy Marsha Doirin | Counselor | 175 Remsen St, Brooklyn, NY 11201-4333 | 2019-11-08 |
| 1689218315 | Arlene A Joseph | Counselor | 175 Remsen St, Brooklyn, NY 11201-4333 | 2019-11-06 |
| 1093359952 | Regina Noel | Counselor | 175 Remsen St, Brooklyn, NY 11201-4333 | 2019-11-04 |
| 1447756440 | Ashley Wong | Counselor | 175 Remsen St, Brooklyn, NY 11201-4333 | 2018-03-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992322267 | Sohrab Singh | Student in an Organized Health Care Education/Training Program | House Staff/gme Office, 121 Dekalb Avenue, The Brooklyn Hospital Center, Brooklyn, NY 11201 | 2020-07-02 |
| 1841812880 | Tara Elizabeth Buentello | Social Worker | C/o The Brooklyn Hospital Center Boy 197, 121 Dekalb Ave, Brooklyn, NY 11201 | 2020-05-13 |
| 1760017842 | New York University | Dentist | 445 Albee Square West, Floors 4a/5a, Brooklyn, NY 11201 | 2020-03-09 |
| 1851924294 | Tbhc Medical Services PC | Clinic/Center | 514 Fulton Street, Brooklyn, NY 11201 | 2020-02-13 |
| 1962040246 | Community Health Project Inc. | Clinic/Center | 40 Flatbush Avenue Extension, Brooklyn, NY 11201 | 2019-12-17 |
| 1558908731 | Ghalab Ali Alhashidi | Pharmacist | 250 Pacific St Apt#26, Brooklyn, NY 11201 | 2019-12-05 |
| 1396394524 | Avis A Sanderson | Specialist | 1 Pierre Point Plaza, Brooklyn, NY 11201 | 2019-09-10 |
| 1316501380 | Alice Weijia Huang | Social Worker | 200 Cadman Plz W Fl 12, Brooklyn, NY 11201 | 2019-04-25 |
| 1093274474 | Wts Medical Staffing, LLC | Home Health | 195 Montague St 14th Fl, Brooklyn, NY 11201 | 2019-03-15 |
| 1366927048 | Anna House | Social Worker | 210 Joralemon Street, Third Floor, Brooklyn, NY 11201 | 2018-09-28 |
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| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770181190 | Kendall Johnson-smith | Social Worker | 108 Kenilworth Place, Comm. 2, Brooklyn, NY 11210-2439 | 2020-10-16 |
| 1316545700 | Emily Rogers | Social Worker | 28 Meserole St Apt 3, Brooklyn, NY 11206-3191 | 2020-10-16 |
| 1841898749 | Deena Grossman | Social Worker | 1014 E 29th St, Brooklyn, NY 11210-3744 | 2020-10-13 |
| 1932706413 | Brooklyn Healthy Mind 360- Nurse Practitioner In Psychiatry Pllc | Social Worker | 26 Court St Ste 409, Brooklyn, NY 11242-1134 | 2020-10-07 |
| 1184221897 | Alexandre David Bauman | Social Worker | 151 Guernsey St Apt 1r, Brooklyn, NY 11222-2848 | 2020-10-06 |
| 1538766308 | Malky Katz | Social Worker | 1621 58th St, Brooklyn, NY 11204-2174 | 2020-10-05 |
| 1881291029 | Andrea M Harris-kornblith | Social Worker | 324 Prospect Ave Apt 1l, Brooklyn, NY 11215-5526 | 2020-10-01 |
| 1255938494 | Juniper Therapeutic Services LLC | Social Worker | 524 Lafayette Ave Apt 4, Brooklyn, NY 11205-4948 | 2020-10-01 |
| 1154938512 | Victor Furtick | Social Worker | 461 Dean St Apt 12p, Brooklyn, NY 11217-4144 | 2020-09-29 |
| 1700493376 | Coral Hain | Social Worker | 830 Marcy Ave Apt 2, Brooklyn, NY 11216-1524 | 2020-09-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.